Epidemiology and healthcare factors associated with neonatal enterococcal infections

Joanna Wang, Christina Kortsalioudaki, Paul T. Heath, Jim Buttery, Paul Clarke, Despoina Gkentzi, Mark Anthony, Kenneth Tan, on behalf of the neonIN network

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3 Citations (Scopus)


Objective: To investigate the epidemiology and healthcare factors associated with late-onset neonatal enterococcal infections. Design: Multicentre, multinational retrospective cohort study using prospectively collected infection data from a neonatal infection surveillance network between 2004 and 2016; this was supplemented with healthcare data from a questionnaire distributed to participating neonatal units. Setting: Sixty neonatal units across Europe (UK, Greece, Estonia) and Australia. Patients: Infants admitted to participating neonatal units who had a positive culture of blood, cerebrospinal fluid or urine after 48 hours of life. Results: In total, 414 episodes of invasive Enterococcus spp infection were reported in 388 infants (10.1% of a total 4083 episodes in 3602 infants). Enterococcus spp were the second most common cause of late-onset infection after coagulase-negative Staphylococcus spp and were strongly associated with necrotising enterocolitis (NEC) (adjusted OR 1.44, 95% CI 1.02 to 2.03, p=0.038), total parenteral nutrition (TPN) (adjusted OR 1.34, 95% CI 1.06 to 1.70, p=0.016), increasing postnatal age (per 1-week increase: adjusted OR 1.04, 95% CI 1.02 to 1.06, p<0.001) and decreasing birth weight (per 1 kg increase: adjusted OR 0.85, 95% CI 0.74 to 0.97, p=0.017). There was no evidence that inadequate nurse to patient staffing ratios in high-dependency units were associated with a higher risk of enterococcal infections. Conclusions: Enterococcus spp were the second most frequent cause of late-onset infections. The association between enterococcal infections, NEC and TPN may inform empiric antimicrobial regimens in these contexts and provide insights into reducing these infections.

Original languageEnglish
Pages (from-to)F480-F485
Number of pages6
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Issue number5
Publication statusPublished - 1 Sep 2019


  • enterococcus
  • epidemiology
  • healthcare
  • infection
  • neonatal

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